AURORA, Ill. (AP) — At her mother’s home in Illinois, Tracy Balhan flips through photos of her dad, Bill Speer. In one picture, he’s smiling in front of a bucket of sweating beers and wearing a blue T-shirt that reads, “Pops. The man. The myth. The legend.”

Balhan’s father died last year after struggling with dementia. During one episode late in his life, he became so agitated that he tried to exit a moving car. Balhan recalls her dad — larger than life, steady and loving — yelling at the top of his lungs.

His geriatric psychiatrist recommended she take him to the emergency room at Endeavor Health’s Edward Hospital in the Chicago suburb of Naperville because of its connection to an inpatient behavioral care unit. She hoped it would help get him a quick referral.

But Speer spent 12 hours in the emergency room — at one point restrained by staff — waiting for a psych evaluation. Balhan didn’t know it then, but her dad’s experience at the hospital is so common it has a name: ER boarding.

One in six visits to the emergency department in 2022 that resulted in hospital admission had a wait of four or more hours, according to an Associated Press and Side Effects Public Media data analysis. Fifty percent of the patients who were boarded for any length of time were 65 and older, the analysis showed.

Some people who aren’t in the middle of a life-threatening emergency might even wait weeks, health care experts said.

ER boarding is a symptom of the U.S. health care system’s struggles, including shrinking points of entry for patients seeking care outside of ERs and hospitals prioritizing beds for procedures insurance companies often pay more for.

Experts also warn the boarding issue will worsen as the number of people 65 and older in the U.S. with dementia grows in the coming decades. Hospital bed capacity in the U.S. may not keep up. Between 2003 and 2023, the number of staffed hospital beds was static, even as emergency department visits shot up 30% to 40% over that same period.

Number of hospital beds at issue

For older people with dementia, boarding can be especially dangerous, Chicago-based geriatric psychiatrist Dr. Shafi Siddiqui said. One research letter published in June 2024 in the Journal of the American Medical Association looked at more than 200,000 patients and found long ER stays could be linked to a higher risk of dementia patients developing delirium — a temporary state of mental confusion and sometimes hallucinations.

“People need to be enraged about (boarding),” said Dr. Vicki Norton, president-elect of the American Academy of Emergency Medicine.

National emergency physician groups have lobbied for years to keep boarding under control. While they’ve made some progress, nothing substantial has changed, despite concerns that it leads to worse patient outcomes.

Dr. Alison Haddock, president of the American College of Emergency Physicians, said that’s because boarding is a failing of the entire health care system that manifests in the ER, so solving it demands a systemic approach.

Federal and state policy decisions made nearly 40 years ago limited the number of hospital beds, said Arjun Venkatesh, who studies emergency medicine at Yale. People are now living longer, he said, resulting in more complicated illnesses.

In 2003, there were 965,000 staffed hospital beds compared to 913,000 in 2023, according to the American Hospital Association. And another JAMA research letter published in February shows there are 16% fewer staffed beds in the U.S. post-pandemic.

The ones available may be prioritized for “scheduled care” patients who need non-urgent procedures, like cancer care or orthopedic surgeries. Insurance companies pay hospitals more for those surgeries, Haddock said, so hospitals aren’t likely to move patients into those beds — even as emergency rooms fill up.

Where can people go?

Though long stays in the emergency department are common, there isn’t good data that tracks the extremes, emergency medicine experts said.

The Centers for Medicare and Medicaid Services recently ended a requirement that hospitals track the “median” wait times in their emergency departments. An advisory group that develops quality measures for CMS recommended that the agency try to more accurately capture long emergency department stays. That measure has recently been submitted to CMS, which can choose to adopt it.

Patients’ families worry that long emergency room stays may make things worse for their loved ones, forcing some to search for limited alternatives to turn for support and care.

Nancy Fregeau lives in Kankakee, Illinois, with her husband Michael Reeman, who has dementia.

Last year, she said he visited the Riverside Medical Center emergency department several times, often staying more than four hours and in one case more than 10, before finally getting access to a behavioral care bed. Riverside declined to comment on Reeman’s case.

During long waits, Fregeau doesn’t know what reassurance she can offer her husband.

“It’s hard enough for anyone to be in the ER but I cannot imagine someone with dementia being in there,” she said. “He just kept saying ‘When am I going? What’s happening?’”

Since November, Reeman has been going to the MCA Senior Adult Day Center in Kankakee. Fregeau said Reeman treats the day center like it’s his job, offering to vacuum and clean, but comes home happier after having time around other people and away from the house.

In Illinois, there are fewer adult day centers than there are counties, and other resources for people with dementia are shrinking, too. A report from the American Health Care Association and the National Center for Assisted Living found that 1,000 nursing homes in the U.S. closed between 2015 and 2022. At least 15 behavioral health centers, which are facilities that specialize in treating mental health issues, closed in 2023.

With fewer places for patients to go after being discharged, hospital beds are being used for longer, exacerbating the boarding problem. It’s becoming more difficult to get a specialty hospital bed, especially when patients’ dementia causes aggression.

That was the case for Balhan’s father, who became increasingly agitated during his ER stay. Hospital staff told Balhan the behavioral care unit wasn’t taking dementia patients, so Speer was stuck in the ER for 24 hours until they found a behavioral health facility, separate from the health system, that would take him.

While the hospital couldn’t comment on Speer’s specific situation, Endeavor Health spokesperson Spencer Walrath said its behavioral care unit typically admits geriatric psychiatry patients, including those with dementia, but it depends on factors like bed availability and the patient’s specific medical needs.

Balhan feels that the U.S. health care system failed to treat her dad as a human being.

“It didn’t feel to me like he was being treated with any dignity as a person,” she said. “If anything could change, that would be the change that I would want to see.”

AP data journalist Kasturi Pananjady contributed to this report.

This story is a collaboration between Side Effects Public Media, a health reporting collaboration of NPR member stations across the Midwest, and The Associated Press. The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group and the Robert Wood Johnson Foundation.

The same images came up repeatedly: vans with ICE written on the side and armed men outside of houses. One girl drew a cityscape, with an oversized X across it.

None of the teens at that session earlier this month had lost a parent to deportation, but the possibility weighs heavily, said Tania Chairez, founder of Convivir Colorado, which focuses on trauma associated with migration.

Sixteen students who participate in Convivr’s programs live within one mile of the Denver-area apartment complexes that U.S. Immigration and Customs Enforcement raided during a major immigration operation in February, and the conversation group is one way they work through their feelings about it, she said.

“They’re sort of helping each other out,” Chairez said.

Immigrant and first-generation American youth will need more mental health support as federal immigration enforcement becomes more aggressive under the Trump administration, and even those who don’t see a parent deported may experience negative effects from worrying about potential family separation and feeling unwelcome, experts say.

While the teens in Convivir’s Arts and Conversations Series drew, they took turns discussing why so many people, including immigrants who arrived years earlier, had negative views of newcomers.

Camila Chavez, 13, said she thought some of the animosity was a reaction to being stereotyped, and the fear that others would look at established immigrant communities as negatively as they do recently arrived migrants who haven’t found work.

“We put pressure on each other to be perfect, so when one of us messes up, we think it’s all going to fall apart,” she said.

Trauma of family separation

Children who lose a parent to an immigration arrest face a heightened risk of anxiety, depression, post-traumatic stress disorder, sleep problems and poor school performance, said Mitra Naseh, research director of the Initiative on Social Work and Forced Migration at Washington University in St. Louis.

But so do kids who fear losing a parent — but are never actually separated — and those separated by circumstances, such as Afghan children whose fathers resettled in the United States after helping the American military but haven’t been able to bring them along, she said.

Family separation, or the prospect of it, is harder for kids to recover from than other types of trauma because children do best when they have adults in their lives who will meet their material and emotional needs, said Dr. Olivia Shadid, an assistant professor of psychiatry and behavioral sciences at the University of New Mexico School of Medicine.

Losing those attachment figures who made them feel safe is a “double hit” on kids’ wellbeing, she said.

“To disrupt these attachment relationships… that really changes how kids see themselves, how they see the world,” Shadid said.

Some studies suggest that immigration enforcement can harm people who feel threatened, even if they aren’t the target.

Babies born to Latina mothers with U.S. citizenship in the aftermath of a major immigration raid were more likely to have low birthweights than those born before the raid – an effect that didn’t show up in the children of white mothers. Hispanic students in schools near raided workplaces also saw a drop in standardized test scores in the weeks afterward, though researchers haven’t determined if they later rebounded.

Raids’ direct impact on a school

Lisyuri Gallardo, a school counselor at Denver’s Place Bridge Academy, said kids are afraid, even if they don’t have a parent at risk of deportation.

Some believe false rumors that ICE is arresting children at school and others know their families aren’t in jeopardy, but worry about their friends’ undocumented parents, she said.

A lawsuit filed by Denver Public Schools seeking to prohibit most federal immigration arrests on school property singled out Place Bridge, which serves a disproportionate number of immigrant students.

The suit alleged the sight of gun-toting federal agents and armored vehicles nearby during the large-scale Denver-area raids on Feb. 5 made Place Bridge students feel unsafe and caused some parents to question whether they should continue sending their children.

DPS officials, in court filings and previous interviews, have said at least four Place Bridge students were detained in the February raids, and multiple students had one or both parents arrested.

A federal judge declined to order ICE away from schools while the lawsuit plays out.

ICE said its February raids in Denver targeted gang members and other undocumented immigrants who had committed crimes, but the agency didn’t release information about the number of people detained or any charges they face.

Adults need to understand that children who are afraid or reeling from a loss can respond in ways that make them look like troublemakers, Gallardo said. While older kids may be able to talk through their feelings, young ones are more likely to shut down or act out, she said.

Some have started missing school or running away during the day because they don’t feel safe.

“There were days (around the raids) when 50% of the students were not here,” she said.

Widespread fear in immigrant kids

Tessa Nelson, program manager for early childhood and youth programs at the Spring Institute for Intercultural Learning in Denver, agreed that fear is widespread among immigrant kids. The Spring Institute has youth and adult education programs aimed at immigrants.

“I’ve had kids contacting me who are full-fledged American citizens, wanting to know, ‘Can my citizenship be revoked?’ ” she said. (It can’t.)

Immigrants, regardless of the path they took to the United States, see the country as a source of hope after life became untenable in their homelands, said Gallardo, who immigrated from Venezuela in 2009. Hearing that significant numbers of Americans don’t want them here is difficult, especially for those who faced danger and may have seen other migrants die on the journey north, she said.

“Surviving immigrating is hard enough, but when you get here and you’re not welcome, that’s really challenging,” she said.

Place Bridge responded to the raids by increasing classroom time spent on stress management skills such as breathing exercises and meditation, Gallardo said. Students who need a bit more support can stop by to talk during the “lunch bunch” group she leads, and individual counseling is available for those who are struggling the most.

But one of the most important things the school can do is keep routines going, she said.

“The more we can provide consistency, the better the little ones do,” Gallardo said.

“In control of an uncontrollable circumstance”

Keeping families involved in school and other activities despite their immigration fears can help soften the blow to kids, particularly if the community provides the sense of belonging that all young people seek out, Shadid said.

Adults around them have to be deliberate about it, though, because people who are afraid of being found out tend to withdraw from social interactions, which doesn’t help their mental health, she said.

Feeling that they’re doing something to help address their fears also helps kids, Nelson said. That can be as simple as memorizing contact information for their parents and someone they could go to in an emergency, or practicing a refusal to answer questions without a parent present, she said.

“That helps you feel more in control of an uncontrollable circumstance,” she said.

Adults also need to shield kids from mistreatment, and not only from people their own age, Nelson said.

At a recent trip to the Denver Zoo Conservation Alliance, she had to step in when an adult man started berating an elementary-aged student who he believed was an undocumented immigrant from Latin America, she said. (The boy was Burmese and had refugee status.)

“He just saw the color of a kid’s skin and decided to yell at an 8-year-old,” she said.

While kids are generally resilient, they can’t learn when they get stuck in fight-or-flight mode, Gallardo said. Most immigrants are dealing with loss, whether of their home, family members who stayed behind, or people who didn’t survive the journey, she said. The possibility of further losses through detention or deportation brings that trauma back to the surface.

“Right now, a family may not be going through a separation, but because they have gone through it, it’s like it’s happening” again, she said.

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At least one dead raccoon from Monte Vista and two raccoon carcasses from Alamosa tested positive for the deadly, contagious disease, the state agency said in a news release.

“In these cases, any other raccoon in the area exhibiting symptoms is presumed to be positive for canine distemper,” District Wildlife Manager Tyler Cerny said in the release. “We are continuing to see more cases.”

Canine distemper is a contagious disease that attacks the respiratory, gastrointestinal and nervous systems of dogs, according to the American Veterinary Medical Association.

All dogs can catch canine distemper, but puppies younger than four months and dogs that have not been vaccinated against the virus are most at risk, according to veterinary officials.

“Canine distemper is a serious disease,” officials wrote on the medical association’s website. “About one in two dogs will die from their infection. Although dogs that survive will have lifelong immunity to canine distemper virus, they usually have permanent, irreparable nervous system damage.”

Canine distemper virus can also infect other mammals, including ferrets, coyotes, foxes, wolves, raccoons and skunks, according to veterinary officials. Cats can get infected but are unlikely to get sick.

The spread of canine distemper is most common through direct contact with infected animals, as the virus does not survive long outside the body, state officials said in the news release.

Symptoms of the virus include:

• Discharge from and crusting around the eyes and nose
• Fever
• Coughing
• Lethargy and reduced appetite
• Vomiting and diarrhea
• Walking in circles or being unable to follow a straight path
• Lack of coordination and muscle twitches
• Convulsions with jaw-chewing movements or “chewing gum fits”
• Seizures
• Partial or complete paralysis
• Hardened nose and footpads

State officials said the symptoms of the disease are not always the same and depend on both the species and how long the animal has been infected.

To avoid canine distemper, state wildlife officials said people should:

• Make sure their pets are up-to-date on vaccinations
• Keep their dogs on a leash when walking
• Not let pets interact with any wildlife
• Not let wildlife frequent their backyard
• Avoid keeping water and food bowls outside to limit possible contamination
• Teach kids not to touch any wildlife

Arapahoe County officials also said in late February that the county was seeing an outbreak of raccoons suffering from canine distemper. It’s not clear how many cases were reported in the area.

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U.S. measles cases topped 700 as of Friday, capping a week in which Indiana joined five others states with active outbreaks, Texas grew by another 60 cases and a third measles-related death was made public.

Health Secretary Robert F. Kennedy Jr. claimed in a televised Cabinet meeting Thursday that measles cases were plateauing nationally, but the virus continues to spread mostly in people who are unvaccinated and the U.S. Centers for Disease Control and Prevention redeployed a team to West Texas.

The U.S. has more than double the number of measles cases it saw in all of 2024, and Texas is reporting the majority of them with 541.

Texas’ cases include two unvaccinated elementary school-aged children who died from measles-related illnesses near the epicenter of the outbreak in rural West Texas, which led Kennedy to visit the community Sunday. The third person who died was an adult in New Mexico who was not vaccinated.

Other states with active outbreaks — defined as three or more cases — include New Mexico, Indiana, Kansas, Ohio and Oklahoma.

The multistate outbreak confirms health experts’ fears that the virus will take hold in other U.S. communities with low vaccination rates and that the spread could stretch on for a year. The World Health Organization has said cases in Mexico are linked to the Texas outbreak.

Measles is caused by a highly contagious virus that’s airborne and spreads easily when an infected person breathes, sneezes or coughs. It is preventable through vaccines, and has been considered eliminated from the U.S. since 2000.

Here’s what else you need to know about measles in the U.S.

How many measles cases are there in Texas and New Mexico?

Texas’ outbreak began in late January. State health officials said Friday there were 36 new cases of measles since Tuesday, bringing the total to 541 across 22 counties — most of them in West Texas. A total of 56 Texans have been hospitalized throughout the outbreak.

Of the confirmed cases, state health officials estimated Friday that about 5% are actively infectious.

Sixty-five percent of Texas’ cases are in Gaines County, population 22,892, where the virus started spreading in a close-knit, undervaccinated Mennonite community. The county has logged 355 cases since late January — just over 1% of the county’s residents.

Last week’s death in Texas was an 8-year-old child, according to Kennedy. Health officials in Texas said the child did not have underlying health conditions and died of “what the child’s doctor described as measles pulmonary failure.” A child died of measles in Texas in late February — Kennedy said age 6.

New Mexico announced two new cases Friday, bringing the state’s total to 58. State health officials say the cases are linked to Texas’ outbreak based on genetic testing. Most are in Lea County, where two people have been hospitalized, two are in Eddy County and one is in Chaves County.

New Mexico reported its first measles-related death in an adult on March 6.

How many cases are there in Kansas?

Kansas has 32 cases in eight counties in the southwest part of the state, health officials announced Wednesday. Two of the counties, Finney and Ford, are new on the list and are major population centers in that part of the state. Haskell County has the most with eight cases, Stevens County has seven, Kiowa County has six, and the rest have five or fewer.

The state’s first reported case, identified in Stevens County on March 13, is linked to the Texas and New Mexico outbreaks based on genetic testing, a state health department spokesperson said. But health officials have not determined how the person was exposed.

How many cases are there in Oklahoma?

Cases in Oklahoma increased by two Friday to 12 total: nine confirmed and three probable cases. The first two probable cases were “associated” with the West Texas and New Mexico outbreaks, the state health department said.

A state health department spokesperson said measles exposures were confirmed in Tulsa and Rogers counties, but wouldn’t say which counties had cases.

How many cases are there in Ohio?

The Ohio Department of Health confirmed 20 measles cases in the state as of Thursday: 11 in Ashtabula County near Cleveland, seven in Knox County and one each in Allen and Holmes counties.

Ohio is not including nonresidents in its count, a state health department spokesperson told The Associated Press. The Knox County outbreak in east-central Ohio has infected a total 14 people, according to a news release from the county health department, but seven of them do not live in Ohio. In 2022, a measles outbreak in central Ohio sickened 85.

The outbreak in Ashtabula County started with an unvaccinated adult who had interacted with someone who had traveled internationally.

How many cases are there in Indiana?

Indiana confirmed six connected cases of measles in Allen County in the northeast part of the state — four are unvaccinated minors and two are adults whose vaccination status is unknown.

The cases have no known link to other outbreaks, the Allen County Department of Health said Wednesday. The first case was confirmed Monday.

Where else is measles showing up in the U.S.?

Measles cases also have been reported in Alaska, Arkansas, California, Colorado, Florida, Georgia, Hawaii, Kentucky, Maryland, Michigan, Minnesota, New Jersey, New York, Pennsylvania, Rhode Island, Tennessee, Vermont, and Washington.

The U.S. Centers for Disease Control and Prevention defines an outbreak as three or more related cases. The agency counted seven clusters that qualified as outbreaks in 2025 as of Friday.

In the U.S., cases and outbreaks are frequently traced to someone who caught the disease abroad. It can then spread, especially in communities with low vaccination rates. In 2019, the U.S. saw 1,274 cases and almost lost its status of having eliminated measles. So far in 2025, the CDC’s count is 712.

Do you need an MMR booster?

The best way to avoid measles is to get the measles, mumps and rubella (MMR) vaccine. The first shot is recommended for children between 12 and 15 months old and the second between 4 and 6 years old.

People at high risk for infection who got the shots many years ago may want to consider getting a booster if they live in an area with an outbreak, said Scott Weaver with the Global Virus Network, an international coalition. Those may include family members living with someone who has measles or those especially vulnerable to respiratory diseases because of underlying medical conditions.

Adults with “presumptive evidence of immunity” generally don’t need measles shots now, the CDC said. Criteria include written documentation of adequate vaccination earlier in life, lab confirmation of past infection or being born before 1957, when most people were likely to be infected naturally.

A doctor can order a lab test called an MMR titer to check your levels of measles antibodies, but experts don’t always recommend it and health insurance plans may not cover it.

Getting another MMR shot is harmless if there are concerns about waning immunity, the CDC says.

People who have documentation of receiving a live measles vaccine in the 1960s don’t need to be revaccinated, but people who were immunized before 1968 with an ineffective measles vaccine made from “killed” virus should be revaccinated with at least one dose, the agency said. That also includes people who don’t know which type they got.

What are the symptoms of measles?

Measles first infects the respiratory tract, then spreads throughout the body, causing a high fever, runny nose, cough, red, watery eyes and a rash.

The rash generally appears three to five days after the first symptoms, beginning as flat red spots on the face and then spreading downward to the neck, trunk, arms, legs and feet. When the rash appears, the fever may spike over 104 degrees Fahrenheit, according to the CDC.

Most kids will recover from measles, but infection can lead to dangerous complications such as pneumonia, blindness, brain swelling and death.

How can you treat measles?

There’s no specific treatment for measles, so doctors generally try to alleviate symptoms, prevent complications and keep patients comfortable.

Why do vaccination rates matter?

In communities with high vaccination rates — above 95% — diseases like measles have a harder time spreading through communities. This is called “herd immunity.”

But childhood vaccination rates have declined nationwide since the pandemic and more parents are claiming religious or personal conscience waivers to exempt their kids from required shots.

The U.S. saw a rise in measles cases in 2024, including an outbreak in Chicago that sickened more than 60.

AP Science Writer Laura Ungar contributed to this report.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

Jefferson County Public Health requested the restraining order close to a year after an inspector hired by Phyllis Phillips found traces of meth in the kitchen, living room, two bedrooms and elsewhere in her rental property.

“(Phillips) continues to rent out units on the property to vulnerable tenants who face grave public health consequences from methamphetamine contamination,” the department wrote in its April 3 request for the order. “Continued access to a methamphetamine-affected property creates a hazardous threat to public safety and a very real and direct threat to the health of the individuals currently residing there.”

The property near Colfax Avenue and Kipling Street is one of at least four used to accommodate clients of the nonprofit Ange De La Mer Alternative Medicine Foundation, where Phillips serves as board president and whose programs include affordable and emergency housing.

Jefferson County has also asked District Court Judge Meegan Miloud to order Phillips to pay a $100 fine and either finish cleaning up the house at her own expense or demolish it.

Phillips on Friday said the inspection and cleanup process has already cost her about $60,000, and she has been trying to pull together more money to complete the additional testing demanded by regulators.

The Colorado Department of Public Health and Environment referred to a meth lab having been on the property in a letter shared with the court by the county. But Phillips said previous occupants of the house only used the drug indoors and did not manufacture it.

She also said the one person still residing at the home is squatting there without her permission.

“I’m just stuck here. I’m trying to get this done,” she said. “I have tried very hard to get everything put back to normal for my property. They act like I haven’t done a thing.”

Phillips said she first hired an inspector to test for meth residue at the property in May following a homicide. Amounts found were dozens of times higher than what would require cleanup by a licensed contractor under state law, according to court documents.

Phillips paid for the decontamination of the property. However, in January, the county wrote in a letter that more testing, and possibly more decontamination work, needed to be done before tenants could return.

The state health department wrote in March that a previously unreported bedroom and RV, both occupied, also required inspection, as did other parts of the property, since the home was found to be permitted as single-family rather than a multi-family dwelling during the cleanup process.

At least three people were said to be living on the property at the time, according to the state.

The Jefferson County Board of Health ordered the immediate testing and cleanup of the property along with the removal of tenants March 18. But the county wrote in its request for a court order that a new occupant had been reported on the property April 1.

Phillips said she plans to pay for the additional testing, though she suspects occupants were not using methamphetamine in the areas that have yet to be tested or cleaned. She also said she does not plan to rent the property as a multi-family dwelling moving forward.

“This place is putting me in debt, big time,” Phillips said.

The next hearing in the case is scheduled for Wednesday.

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A Denver District Court jury on Wednesday found that the insurer, NorGUARD Insurance Company, illegally delayed and denied Fermin Salguero-Quijada’s workers’ compensation claim, blocking him from receiving necessary medical care and eliminating the chance to avoid making his disabilities permanent, according to the 2023 lawsuit that prompted the week-long trial.

“As a further direct and proximate result of defendants’ wrongful conduct, as stated above, including the delays and/or denials of plaintiff’s reasonable and necessary medical treatment, plaintiff, at age 22 years old, is now permanently and totally disabled from any employment that he was able to perform prior to his work-related injury,” the lawsuit states.

Salguero-Quijada fell at least 15 feet from a ladder while working as a painter for a Colorado company in Salt Lake City on Sept. 24, 2021. He was taken to the University of Utah Hospital, where doctors diagnosed him with serious brain hemorrhages. The 20-year-old had no motor response and no verbal response and was placed on life support.

Salguero-Quijada remained at the Utah hospital for two months. His doctors planned to discharge him to Craig Rehabilitation Hospital, but could not because NorGUARD Insurance Company — owned by Warren Buffett’s conglomerate Berkshire Hathaway — had not admitted liability for the workers’ compensation claim and therefore would not pay for his care there, the lawsuit states.

A doctor ordered ongoing neurology and neurosurgery consultations, physical therapy, occupational therapy, speech therapy, MRIs, acupuncture, eye care, and an orthopedic consultation for wrist fractures.

Instead of inpatient care, family members in Aurora took on the responsibility of caring for Salguero-Quijada, which included helping him with daily necessities like communicating, dressing, eating, walking and bathing. He required 24/7 direct supervision, according to the suit.

More than a month after the fall, the painting company’s workers’ compensation insurer, NorGUARD Insurance Company, denied Salguero-Quijada’s workers’ compensation claim. First, the company said it needed more time to investigate the issue. Then, the company said that the insurance company for the contractor that hired the painting company Salguero-Quijada worked for should be responsible for the claim instead of them.

The 20-year-old’s family contested the denial, which didn’t go to a hearing until July 2022 — 10 months after the fall.

Even after a judge ruled that the insurer should pay the claim, NorGUARD Insurance Company appealed the decision and, when the company lost again, continued to delay and deny payment for Salguero-Quijada’s medical needs. Salguero-Quijada’s family sued in November 2023.

The jury on Wednesday found that the insurance company knowingly acted unreasonably when it denied and delayed the workers’ compensation claim and caused him physical and emotional harm. Of the $145 million the jury awarded, $60 million were punitive damages — meant to punish the defendant.

The lawsuit also alleges that the nurse assigned to Salguero-Quijada’s case repeatedly delayed or failed to set up needed care for the injured man.

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“We’re not waiting to make our case,” U.S. Rep. Jeff Crank said in an early morning video call with reporters. “We’re making our case and we’re doing it right now. We’re going to continue to fight — it makes sense that it be in Colorado. It’s already in Colorado.”

Crank is a freshman who represents the 5th Congressional District where Peterson Space Force Base, home to Space Command, sits. He was joined by Reps. Lauren Boebert, Gabe Evans and Jeff Hurd, who spoke from an office at the U.S. Capitol in Washington, D.C.

Members of Alabama’s congressional delegation have been spinning a different story this week, with U.S. Rep. Mike Rogers saying on a podcast that contractors are “ready to turn dirt” on a future Space Command headquarters at the Army’s Redstone Arsenal in Huntsville.

Rogers, chairman of the House Armed Services Committee, told Auburn University’s “Cyber Focus” podcast Tuesday that he expected a final decision from the Trump administration this month.

“We do expect it to be announced right after the Air Force secretary is named,” he said.

President Donald Trump in January nominated former air crewman and space expert Troy Meink to lead the Air Force. He hasn’t been confirmed to the post yet.

But Colorado’s Republicans were hopeful that no move would happen.

“I’ve asked many of our senior military leaders: What is the military value of moving Space Command out of Colorado Springs?” Crank said Thursday. “And, point blank, they say there isn’t any.”

Evans, who represents Colorado’s 8th Congressional District and is an Army veteran, said he was encouraged by the fact that Trump didn’t immediately move Space Command upon taking office nearly three months ago — as was predicted by Rogers shortly after the November election.

“There were a lot of rumors swirling that this was going to be one of those first executive orders dropped on Jan. 20,” Evans said. “As we all know, there was no executive order on Day 1 talking about Space Command.”

Space Command, which is responsible for the nation’s military operations in outer space, was revived in 2019 under Trump’s first administration. Located first in Colorado Springs, it was set to move to Alabama after Trump announced that state as his selection for a permanent headquarters in the waning days of his first administration in early 2021.

But former President Joe Biden later reversed that decision and the command remained in Colorado. The Denver Metro Chamber of Commerce estimates it supports nearly 1,400 jobs and has a $1 billion impact on the local economy.

Huntsville, home to some of the earliest missiles used in the nation’s space programs, scored higher than Colorado Springs in a Government Accountability Office assessment of potential locations for the command. That same office, however, gave the selection process low marks for documentation, credibility and impartiality and said that senior U.S. officials who were interviewed conveyed that remaining in Colorado Springs “would allow U.S. Space Command to reach full operational capability as quickly as possible.”

With rising military threats from Russia and China, Boebert said Thursday that it was “even more critical for Space Command to avoid being moved across the country.”

The minimum $2 billion price tag to relocate the command would undermine the priorities the administration has set with its budget-cutting Department of Government Efficiency office.

“It really flies in the face of the DOGE operations that are taking place,” the congresswoman said on the call.

The Republican delegation on Monday sent a letter to the White House outlining Colorado’s position on the issue. They wrote that a move to Alabama “would introduce unnecessary risks, disrupt established operations and waste valuable resources.”

The state’s Democratic members of Congress, along with both of the state’s Democratic U.S. senators, have also been vocal about keeping the Space Command in Colorado.

On Thursday’s call, Crank said that with the president’s announcement during his first week back in office of the creation of the Golden Dome missile defense system — a futuristic network of U.S. weapons in space designed to destroy ground-based missiles within seconds of launch — it’s all the more critical to keep Space Command in Colorado.

“We have to have this seamless coordination between (Colorado Springs-based) Northern Command and Space Command, especially if we’re going to be successful implementing Golden Dome,” he said. “They literally share the same parking lot at Peterson Space Force Base, so I believe there would be a great loss in capability there.”

The Associated Press contributed to this report.

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David Freilino allegedly shot and stabbed Bonnie Young, 64, to death outside her home in Gardner on April 5, 2023. He pleaded not guilty by reason of insanity in May, meaning his attorneys aren’t contesting that he attacked Young, but argue that he isn’t legally responsible because his mental illness prevented him from telling right from wrong, according to The World Journal newspaper in Walsenburg.

The victim’s husband, Ronald Young, filed a lawsuit Friday in Pueblo District Court alleging that Spanish Peaks Regional Health Center failed to identify that Freilino had a severe mental illness and needed involuntary treatment to prevent him from harming others.

The lawsuit said deputies from the Huerfano County Sheriff’s Office responded to Freilino’s property, which adjoined the Youngs’, one day before the shooting. They transported him to Spanish Peaks Regional Health Center under an involuntary mental health, or M-1, hold.

Young alleged that Freilino exhibited “bizarre” behavior suggesting he may have experienced psychosis — hallucinations or delusions — but the hospital’s behavioral health contractor, Health Solutions, cleared him to go home the same day without performing a mental health evaluation.

Federal law requires hospitals to screen anyone who comes into their emergency departments, and to stabilize them for either transfer to another facility or discharge. Patients can choose to leave without being stabilized, unless they are at an imminent risk of harming themselves or others, which would qualify them for involuntary commitment.

“The health care providers at Spanish Peaks Regional Health Center… knew or should have known that Mr. Freilino required immediate and emergent, in-hospital, psychiatric care and treatment,” the lawsuit said.

Representatives for the hospital and Health Solutions said they couldn’t comment. The Huerfano County Sheriff’s Office referred questions to its attorney, who didn’t respond.

Law enforcement can bring someone in under an M-1 hold, but medical providers have to make their own judgment about whether the person is an imminent risk to themselves or others and discharge them if that’s no longer the case, said Vincent Atchity, president and CEO of Mental Health Colorado.

Symptoms of severe mental illness can look different from moment to moment, he said.

“‘Imminent’ is in some ways an impossible term,” he said. “The sheriff may have grabbed somebody when they’re agitated or psychotic, but by the time they get to a clinical setting, they’re calm.”

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But since 10-week-old Sam’s birth in January, she has also missed around 50 votes while staying home in Lakewood to care for him. That was all the more reason for Pettersen’s disappointment this week after a resolution she had co-authored — to give new parents in Congress the power to vote by proxy for 12 weeks as they care for their newborns — fizzled over the weekend.

“If you gave birth, it is a very intense few weeks in a recovery period, post birth,” Pettersen, a Democrat, said in a phone interview from Washington on Tuesday. “So this is not like you’re hanging out on vacation at home. These are very real medical circumstances that prevent you from being able to travel across the country to be there in person.”

Even though she was joined by Republican U.S. Rep. Anna Paulina Luna of Florida, plus nearly a dozen other GOP members of Congress, the push for the proxy vote ran into strong resistance from House Speaker Mike Johnson.

The Republican speaker has vigorously opposed the effort, calling it an affront to the Constitution that would open “Pandora’s box.”

On Sunday, Luna, also a young mother, announced that she had reached a compromise with the speaker. Rather than allow proxy voting, the agreement would formalize a “pairing” system long used in Congress, in which one member who is physically present in the House cancels out the vote of someone who is absent.

Pettersen, 43, on Monday took to X to thank Luna for her efforts on the issue but wrote that “this outcome does not address the barriers we’ve fought so hard to overcome.”

In her interview with The Post, she said that in the face of Johnson’s resistance, the push for a proxy vote “became insurmountable.”

“It makes no sense that in the 21st century, we are unable to accommodate for a vote being counted — just because we aren’t physically present when we’re unable to do so,” she said. “We’re so far behind the times in Congress (with) the way that we do things, you know, the focus and priorities. And that’s because we need to change the faces and voices and life experiences represented here — and I’m hopeful that we have young parents who have joined together to try to shake things up.”

Proxy voting had been put into effect under a Democratic-controlled Congress for around two years during the COVID-19 pandemic. But it didn’t last.

Last week, Johnson endured a decisive defeat after he staged an aggressive effort to squash the Luna-Pettersen proposal. Nine of his own Republicans joined all Democrats in rejecting his plan.

And just days after that vote, Pettersen’s resolution appeared to get an additional shot of life when President Donald Trump expressed support for it. Though the Republican president said he would defer to Johnson on the operations of the House, he also said: “I don’t know why it’s controversial.”

Pettersen said she was “very surprised” by the president’s position on the issue.

“You know, this is something that we agree on,” she said over the phone as Sam could be heard cooing in the background. “But this shouldn’t be controversial, and the rest of America agrees on that.”

As for the future of proxy voting for new parents in Congress, Pettersen said she was ready to continue to do battle. She said she wanted to start by forming a bipartisan parents caucus “so that we can have power in numbers when it comes to the schedule.”

“Obviously, we faced some setbacks, but the fight is far from over — and I know that we’re going to continue to work to get this done,” Pettersen said. “This issue is not going away.”

The Associated Press contributed to this story.

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Last week, the Colorado Department of Public Health and Environment announced an unvaccinated adult in Pueblo had contracted measles — the state’s first confirmed case since 2023 — while traveling to Mexico.

On Monday evening, the agency reported an infant in Denver also tested positive for measles after traveling to Mexico, and, on Tuesday, it announced a third case in Archuleta County, in southwestern Colorado.

That person, an adult whose vaccination history isn’t yet known, hadn’t left Colorado and didn’t cross paths with either of the other two patients, meaning the state may have measles cases spreading undetected, state epidemiologist Dr. Rachel Herlihy said.

“We urge Coloradans to monitor for symptoms if they may have been exposed, and to make sure they are up to date on their (measles, mumps and rubella) vaccinations,” Herlihy said in a news release.

Public health officials have warned about potential exposure sites in Pueblo, Denver and Pagosa Springs.

The Denver patient, an infant under 1 year old, contracted measles during a recent visit to an area of Chihuahua, Mexico, that is currently experiencing an outbreak, according to city and state public health officials. Denver Health discharged the baby home, where they are doing well, the Denver Department of Public Health and Environment said Tuesday.

People who visited Denver Health’s emergency department, 777 Bannock St., between 10:30 a.m. and 4:30 p.m. Sunday could have been exposed to measles. Symptoms can take up to 21 days to appear, so any exposed person who isn’t vaccinated should avoid public gatherings for three weeks, according to the health department.

“This case is a stark reminder that families traveling internationally should delay unnecessary travel or talk to their health care providers about early MMR vaccination for infants, especially when visiting areas with known measles outbreaks,” Herlihy said in a news release.

The Archuleta County case was contagious from March 26 to April 3, according to the state health department. Others could have gotten the virus if they were at Wolf Creek Ski Area and Resort at any point from March 28 to 30; City Market at 165 Country Center Drive in Pagosa Springs, from 10 a.m. to 12:45 p.m. March 31; or Pagosa Medical Group, 27B Talisman Drive in Pagosa Springs, from 9:05 a.m. to 12:15 p.m. March 31 or 3:45 to 6 p.m. April 2.

Archuleta County has one of the lowest vaccination rates in the state, with about 87% of K-12 students up-to-date on their measles vaccines during the 2023-2024 school year.

Neither of the new cases is related to a case in Pueblo in an unvaccinated adult who also visited Mexico. That person visited Southwest Deli and Cafe in south Pueblo from March 17 to 21, as well as the Southern Colorado Clinic in Pueblo West and the South Side Walmart in Pueblo on March 22.

Initial measles symptoms include a fever, cough, runny nose and red eyes. The distinctive rash doesn’t appear until the person has already been contagious for about four days. People who could have been exposed and have symptoms should call their health care provider before coming in, so the provider can take precautions to avoid exposing others.

Two doses of the measles, mumps and rubella vaccine are 97% effective in preventing measles. People who survived it also generally have lifelong protection. Doctors don’t recommend trying to get measles, though, because of the risk of pneumonia, neurological damage and death.

Two children and one adult have died this year in outbreaks in west Texas and New Mexico.

Vitamin A may be useful in treating children who have measles, but it doesn’t prevent infection. Parents shouldn’t give vitamin A without a doctor’s supervision, because giving too much can cause liver damage.

Children can receive their first measles shot at about 1 year old and their second between 4 and 6. Babies who are going to travel abroad can receive an early shot from six months on.

As of Friday, the United States already had twice as many measles cases as it did in all of 2024. Most are in Texas, where 481 people caught the virus and 56 needed hospital care.

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